The REBOOT First Responders Program: Insights of U.S. Graduates

Abstract

The REBOOT First Responders program offers spiritual care for occupational stress. Although prior work suggests benefits to the program, no research has considered attendees’ experiences in an open-ended way. The aim of this study was to document first responders’ thoughts about the effectiveness, evaluation, and effects of the course in their own words. Interviews with 36 graduates living in the U.S. indicated favorable perceptions of the course. Reasons for success included the program’s tangible benefits, community atmosphere, and faith-based approach (RQ1). Strengths involved helping first responders realize they are not alone and educating them about trauma; recommended upgrades involved customizing to specific occupations and offering ongoing support (RQ2). Effects included more self-acceptance, enhanced spirituality, better relationships, a more constructive view of trauma, and greater optimism about the future (RQ3). These results have implications for improving spiritual care for first responders.

Appendices

Appendix A

REBOOT First Responders Curriculum Outline

Session 1: The Gateways of Trauma   The first session introduces the format of the course and examines six issues first responders face that can lead to occupational stress, trauma, and posttraumatic stress. Session 2: Change the Roots, Change the Fruits   Session 2 helps individuals identify soul wounds in their lives by delineating between natural trauma (i.e., affliction beyond anyone’s control) and malevolent trauma (i.e., affliction caused by self or others). It emphasizes that people’s current well-being is rooted in their past experiences. Session 3: Purpose in Your Pain   This session considers how to transform posttraumatic stress into posttraumatic growth. It invites attendees to view adversity as a strengthening agent in their lives. Session 4: Making Choices to Heal   Session 4 discusses the role of free will in how people cope with trauma, the benefits of being intentional during the healing process, and the value of abandoning destructive ways of numbing pain. Session 5: Unloading   This session distinguishes between anger and angry outbursts, explores how to deal with triggers that can lead to volatile emotions, and describes how to manage anger before it boils over. Session 6: Collateral Damage   Session 6 covers how to handle loss and grief by drawing on the Scripture story of how Jesus coped with the death of good friend Lazarus. It tackles the question of how a benevolent and loving God can allow trauma, adversity, and pain. Session 7: Walking through Death Valley   This session depicts how depression can lead to thoughts of suicide, along with major causes of suicide ideation and warning signs of suicide. It also examines how to deal with suicidal thoughts experienced by self and others. Session 8: Guilt and Innocence   Session 8 explains the difference between true guilt and false guilt, how to respond to both kinds of guilt, and the freedom that comes from seeking forgiveness from God. Session 9: Forgiven and Forgiving   This session discusses accountability and restitution in forgiveness. It also teaches attendees how to forgive others who commit harm and how to forgive themselves when they transgress their own moral code. Session 10: Your True Identity   Session 10 considers how traumatic events can disrupt people’s view of themselves, hamper their confidence, and downgrade their self-esteem. It emphasizes strategies for reconstructing a positive self-image based on truths from Scripture rather than on worldly influences. Session 11: Share Your Story   Attendees have the opportunity to prepare and share the story of the stressors that have shaped who they are today. Listeners offer encouragement, affirmation, and prayer support. Session 12: Graduation Ceremony   The final session takes the form of a graduation ceremony honoring the attendees for the work they have done during the program. Attendees are encouraged to invite their family members and friends to the event.

1. Copyright © 2019 REBOOT First Responders. Reproduced with permission. All rights reserved

Appendix B

Sample Interview Questions

What are your overall impressions of the REBOOT First Responders program? What aspects of the course were most helpful for you? Why? What aspects of the course were least helpful for you? Why? What would you change about REBOOT? What would have made your group’s leadership team better? How, if at all, did the course affect the way you see yourself? How, if at all, did the course affect your relationship with God? How, if at all, did the course affect your relationships with others? How, if at all, did the course affect the way you view your trauma experiences? What changes in your life, if any, resulted from REBOOT? How effective was REBOOT for helping you cope with first responder stress? What are the reasons that REBOOT was effective or not effective for helping you? What other services, if any, have you used to deal with first responder stress? How effective was REBOOT compared to the other approaches you have tried?

Appendix C

Effectiveness of the Program

1. Favorable Overall Perceptions of the Program   “It was just an incredible experience to watch the transformation from people being stoic and apprehensive and scared to open up to just billowing with emotion. It’s a great program.” –Bruno, health care and social services   “I thought it was great! It was really good to have something that was geared specifically towards first responders and their significant others.” – Jane, dispatch and social services   “It was an amazing experience. I’ve made friends to hang out with, and to this day, we are support for each other. The material was wonderful, and it was well presented. I didn’t expect much from a free program, to be honest. But they just wanted me to up my healing process.” – Neil, law enforcement, dispatch, corrections, and social services 2. Program Facilitates Healing   “It was very, very effective. Before that, I would sit back and say, ‘I’m fine. I don’t have any problems.’ When we made it to the end and we shared our story, I brought up things that I didn’t even know were bothering me. It’s affected me in a really, really positive way.” – Vincent, law enforcement   “It was very helpful. It helped me pinpoint what is actually wrong with me and helped me realize what was going on. I still have my bad moods, I still hate large crowds, I still have really bad anxiety. But, whenever I have a flashback or anything like that, the [curriculum] section on ways to snap out of it has helped me turn those episodes from an all-day event to a 10, 15, 20-min event.” – Giles, law enforcement   “Well, for one, feedback from people I had no idea were watching. Someone at work, he’s like, ‘I just gotta tell you something. You’re just a happier person.’ And it was right after graduation. That’s how I knew I changed, because I was being viewed differently by my coworkers. I’ve been around these people for five or six years, and no one ever told me I was grumpy to begin with. But then, when they tell you you’re not, you’re like, ‘Oh, something’s changed.’ I’ve had multiple people tell me that.” – Meg, dispatch 3. Program Fosters Camaraderie with Other First Responders   “Sometimes a therapist doesn’t understand why you feel this way, because they’ve never been in the situation. But with REBOOT, everyone has been in your shoes, so they’re able to help you break things down, talk about it, and find some resolution. It’s a great support system, because even though the class is over, I can still pick up the phone or message any one of those people in that class.” – Emma, law enforcement   “There’s a camaraderie among fire, EMS, police. So, it was kind of nice to only have first responders in that group. When I’m talking to them, I feel like I’m talking to my people. I feel like I understand what they’re saying, and how they’re saying it, and what perspective they’re coming from. So, the group dynamic there.” – Jeremiah, fire safety and emergency medical services   “It was nice to have an option to talk with other first responders in a safe place.” – Rita, dispatch 4. Program Emphasizes Spiritual Health   “I spent more time reflecting purposefully with a Christian point of view.” – Barbara, health care   “Knowing that support was there in a spiritual form.” – Neil, law enforcement, dispatch, corrections, and social services   “The Scriptures was one reason why it was effective.” – Matthew, emergency medical services

Appendix D

Evaluation of the Program

1. Program Shows Attendees that They are Not Alone   “How much I was able to relate with the other participants. Through conversation, I realized that even though our situations circumstantially were very different, experientially they were very similar, and so I didn’t feel as isolated and alone anymore.” – Alec, fire safety and health care   “You always think you’re alone when you’re depressed. And REBOOT, they emphasize it: ‘You’re not alone.’ There’s somebody who can help you, because you’re not alone.” – Clare, social services   “Realizing that a lot of people are going through the same things that I am, but the nature of the business is that you hide it, because the first thing they want to do is take you off the road.” – Herbert, fire safety, emergency medical services, and dispatch 2. Program Offers a Better Understanding of First Responder Trauma   “REBOOT gave me a different worldview about things. It helped me and gave me mental tools that I could use. Let me put it this way: My previous mental processes were deficient. I didn’t have enough understanding of [trauma] or what was going on behind the scenes.” – Carl, law enforcement, fire safety, and emergency medical services   “It brought a lot of things to light that I didn’t even know I was dealing with.” – Vincent, law enforcement   “To deal with my PTSD, to deal with my night terrors, getting a sense of self-awareness is what helped me the most.” – Giles, law enforcement 3. Tailor Curriculum to First Responder Fields   “I was the only street cop in there. The instructor had some military police experience, but the other participants were all nurses and stuff like that, so I just felt out of place. And it’s not practical to think that you’re going to find all these instructors who are super well-rounded and have all this awesome experience, but I couldn’t relate to anybody there.” – Ignacio, law enforcement   “Dispatchers are considered first responders. But at the same time, they’re not. As far as changing the course, the only thing I would like to see is it branch out a little bit more to the unsung heroes who aren’t really considered first responders.” – Giles, law enforcement   “Push for more fire, police, and EMS personnel to do it. A respiratory therapist was there [during COVID], and granted, they do experience trauma, but I don’t see it as the exact same type of trauma.” – Colin, law enforcement, fire services, and emergency medical services 4. Provide a Longer Duration of Support   “The only thing I would change is not having an end to it. Keep it open ended. Like an AA meeting, you know, just have it available if somebody has in issue. If all of a sudden we have a critical incident in the fire department, and if something does come up, it’s so much easier to talk to someone that we’ve worked with before.” – Fred, fire safety and emergency medical services   “Go past the 12 weeks, or maybe add some other stuff to extend it beyond 12 weeks, but break it up. Like, you’ve got the first 12 weeks, and then maybe some additional stuff that would be like a second level of the course.” – Herbert, fire safety, emergency medical services, and dispatch   “REBOOT was effective initially. For about a couple months afterwards, I was able to effectively deal with some stuff, but after that it was just a gradual decline. Maybe a supplement or a group setting specifically geared towards first responders once a month or once every two months.” – Matthew, emergency medical services

Appendix E

Effects of the Program

1. Enhanced View of Self   “I accept myself better.” – Roger, law enforcement, dispatch, and health care   “I see myself in a very much more positive light. I see good things in my future, instead of no future at all.” – Neil, law enforcement, dispatch, corrections, and social services   “I understand myself better. Of how stuff happens and some of this stuff you can’t control. You have to kind of roll with it and accept yourself for who you are.” – Dominic, fire safety and emergency medical services 2. Stronger Relationship with God   “Oh, it deepened it extremely. It just made me realize that God is really the center of my life, and the more I put into my relationship with God, the more I’m going to get out of it.” – Carl, law enforcement, fire safety, and emergency medical services   “I will just say that that it changed my perspective from some of the things that I was being locked down into from my PTSD. It showed me that that God was there, so to answer your question, it brought me much closer to God than I had been in a long time. But it also reaffirmed the fact that He was there all along and He always is.” – Timothy, fire safety and corrections    “It definitely improved it. I hadn’t been in church for probably 10 years.” – Meg, dispatch 3. Better Relationships with Others   “REBOOT helped me be a little more understanding of where people are coming from. In terms of family, I think I was just more patient.” – Barbara, health care   “I’m having an easier time opening up to people and building relationships. After REBOOT, I’ve become a lot closer to my husband. We’ve been able to talk through a lot of stuff that we couldn’t before and cope with a lot of it together. I think it’s allowed me to be open with more people and not be fearful of being judged.” – Justina, emergency medical services   “I don’t hate anybody anymore. I did hate my stepdad for years and years. He beat my mom and he was an alcoholic. There would always be triggers when certain TV shows would come on, or certain foods, or whatever, and I would feel that anger build up. And, I don’t feel that anymore. I do credit some of the course for helping me to get on that path of where I am right now.” – Dominic, fire safety and emergency medical services 4. Transformed View of Trauma   “Basically I realized that it was nothing I could have changed. Something was bound to happen, whether I knew it or not, and I have to deal with it in a way that will be beneficial to myself and my family and my future. It’s my own truth and I can’t run away from it. If I keep running from the past, then it’s never going to be healed, and it’s never going to be forgotten. I can now share my experience, even if it’s challenging, and use it as an example to better others.” – Gwen, dispatch and social services 5. Better Outlook on Life   “I have peace of mind. Between the contact that I’ve had with this organization for the last four years, four and a half years, and you know getting back into the world and just finding peace within my life.” – Timothy, fire safety and corrections   “A more balanced perspective.” – Damian, law enforcement, fire safety, emergency medical services, and dispatch   “I’ve come to grips more with who I am and what I want my future to be. I’m not the scared person who never wants to leave the house anymore. I’m not ready to go work in an ambulance company again, but I don’t freak out every time an ambulance drives by anymore. Sirens don’t set me off like they used to.” – Justina, emergency medical services